Now that the warm summer months are becoming a distant memory for many of us, one major focus in my office is on hyperpigmentation that’s still lingering on my patients’ skin into the winter months. Specifically, melasma, also called the “pregnancy mask”, is common and can be incredibly frustrating. 

Melasma is a type of hyperpigmentation which is characterized by dark brown or gray-brown patches of skin on your cheeks, forehead, upper lip, or along the lower cheeks and jawline. My patients often describe it as having the appearance of “paint splatter” on their skin.  The excess pigment can be in the upper layers of your skin, or the deeper layers, or both. If you have excess pigment in the deeper layers, that can be much more challenging to treat.

A question I’ve been getting all the time on this subject is: Should I use retinol or bakuchiol if I have melasma?

Whereas retinol can be a bit of a diva in that it can be an irritant. Anyone who has tried a retinol has been there: you use it liberally for a few nights in a row and think: “No big deal! What’s all the fuss? My skin is doing fine.”  Then, about 4-5 days in, you find your regular moisturizer that you use all the time is making you red, blotchy and stings like crazy when you apply it. Then, you start to see the flakes, and you officially have a full blown case of “retinoid dermatitis!”

The new kid on the block, bakuchiol, is not irritating in the same way, and has been found to actually help soothe irritated skin!  When compared to retinol, bakuchiol is also very effective at reducing hyperpigmentation. This is so important because we know that irritation can actually exacerbate your melasma, making it worse. So although retinoids are so great at lightning the skin, it was always a delicate balance between getting the benefits without creating inflammation which we know could set melasma patients back.  

Now, we don’t have the same mountain of evidence for bakuchiol as we do for retinol because bakuchiol is so new on the scene, but the studies I’ve seen have been very, very promising and exciting on this front.

Also, bakuchiol is a great option for hyperpigmentation/melasma patients because it is not photosensitizing, meaning it won’t make your skin more susceptible to sun damage. Many retinol products, in contrast, are best used at night because they can make your skin more sensitive to the sun. 

Third, bakuchiol acts as an antioxidant, which is very beneficial for melasma patients given that oxidative stress and free radicals contribute to melasma. 

Finally, pregnancy and nursing often coincide with melasma (also known as the “pregnancy mask”), but we do not recommend use of retinol if you are pregnant or nursing. So, bakuchiol is a great option to help dial down melasma while you are pregnant or nursing. 

Here are some of my favorite bakuchiol products: 

Herbivore Botanicals Bakuchiol Retinol Alternative Serum-very lightweight, easily layers under your moisturizer.

Beauty Counter Countertime Tripeptide Radiance Serum 

You guys have asked so many great questions about melasma, so keep ‘em coming!

 

Dr. Whitney

You guys asked so many great questions about clean beauty! Check out my responses:

  1. How does Retinol/Retin-A fit into the clean beauty picture?

ANSWER: Retinol is a Vitamin A derivative which is often added to topical skincare products to promote skin renewal, brighten skin tone, reduce acne, and boost your skin’s collagen production. It also functions like an antioxidant to help address free radical damage which leads to visible signs of aging. The term retinoids is most commonly used to cover the class of Vitamin A derivatives which includes over-the-counter retinol and prescription strength Retin-A.  Retinol is probably the most powerful over-the-counter anti-aging ingredient on the market today and has the most impressive data when it comes to truly transforming our skin, provided that we use it consistently over time. I often recommend that my patients who are starting to notice fine lines and wrinkles (typically ages 30+) incorporate an OTC retinol into their nightly skincare routine. Retinol helps to diminish the appearance of fine lines and wrinkles, improves your overall skin tone and appearance and can even help to reverse some of the side effects of sun damage. When applying it, don’t neglect your neck, chest, and eye area. If you are using a retinol to address fine lines and wrinkles, I often tell my patients that they will see the clearest visible results in about 6 months with even more impact after one year. In the case of retinol, in my opinion, natural alternatives just haven’t caught up to the efficacy of safe, consistently effective, synthetic ingredients formulated in a lab. You might see some products containing rosehip seed oil, or beta carotene, with claims that the product has “natural retinol alternatives.” While these ingredients do have some nice benefits for the skin, they aren’t going to deliver comparable results to a synthetic retinol made in a laboratory. I regularly test new products, so if I find a product that changes my mind, I will share that information!

2. What clean beauty ingredients or products do you recommend for dry, acne prone , sensitive skin?

ANSWER: As I share in Dirty Looks, I would consider addressing these symptoms using a 360 degree approach, including dietary changes, in addition to topical products. We now know that certain foods can trigger acne, including whey protein and skim milk. Many times, internal inflammation, which begins in our gut, manifests externally as sensitive skin, acne, dryness, etc. So, that is where I would begin. In terms of clean beauty products, I would avoid any harsh cleansers or scrubs that will disturb your skin’s gentle natural barrier and healthy microbiome. A gentle cleanser would be a great option. Look for the words “gentle,” “hydrating” or “pH balanced” on the label.  When it comes to exfoliating your skin, make sure to limit any form of exfoliation to twice a week and for sensitive skin, I prefer chemical over physical or manual exfoliants.  Here’s a facebook live I did on exfoliating that you might find helpful. Since your skin is acne prone, you want to look for words like “non-comedogenic”, which means that the product will not clog your pores.

  1. Clean beauty in sunscreen – is this even possible?

ANSWER: This is such a great question because the terms we see advertised on sunscreen bottles can be incredibly confusing. For example, does organic mean natural? Actually, organic sunscreen technically means that the sunscreen includes carbon-based ingredients like oxybenzone and avobenzone. Organic sunscreens, according to dermatologists and chemists, are the chemical sunscreens. In contrast, physical blockers – which are minerals – are inorganic, meaning not-carbon based and include zinc oxide and and/or titanium dioxide. So, you truly have to check the label to know whether your “organic” sunscreen is the type of sunscreen you think you are buying! Some of my favorites, which would be in sync with most definitions of clean beauty, are: Naturopathica UV Defense Cream and ThinkBaby SPF 50+ Sunscreen.

  1. Is xanthan gum safe? It’s in a lot of clean beauty products.

ANSWER: Xanthan gum is a polysaccharide. It’s basically a sugar-based polymer, or chain, produced by bacteria. It’s commonly used in cosmetics, many foods, supplements . . . it can be found in so many ingestible and topical products. It can be a digestive irritant if consumed in large quantities, but overall, based on available studies, it doesn’t appear to pose substantial health concerns. It does not appear to be absorbed into our bloodstream and I have not seen any studies to date that specifically concern me when it comes to topical usage.

  1. Is grape seed oil as a body moisturizer safe for everyday use?

ANSWER: In general, grapeseed oil does appear to be safe based on what we do know, provided that it’s cold-pressed or expeller-pressed. Grapeseed oil might have some beauty benefits due to its Vitamin E and omega-6 fatty acid content. It can be used for oil cleansing and can protect against skin irritation. I would like to see more studies on grapeseed oil usage, particularly with respect to everyday use, though, before I come to a conclusion on whether that’s beneficial.

  1. What do you think about parabens? Cetaphil is so often recommended and I’ve been using it for years but I know there is some concern about parabens.

ANSWER: This is a great question because parabens have been so widely used as a preservative in beauty and skincare products for so many years and now, we are seeing so much attention called to “paraben-free” products. So, the question is, what is the danger here and why are parabens getting so much negative attention? Currently, the US Food and Drug Association and World Health Organization consider parabens to be safe at low levels. The main concerns with parabens surround whether they are hormone disruptors. Specifically, estrogen disruption has been linked to cancer and reproductive issues and the questions surrounding parabens relate to these subject matters. Therefore, many companies are including parabens on their “dirty lists” and emphasize that their products are “paraben-free.” Parabens include Ethylparaben, Butylparaben, Isobutylparaben, Isopropylparaben, Methylparaben, and Propylparaben. I have been very much aligned with the clean beauty space and the direction of clean beauty and I do think that mindfulness is warranted when it comes to paraben use. There are so many options now that are paraben-free that I feel it makes good sense to embrace those products and to move away from products which are made with parabens while further research is done with respect to their safety.

  1. Are essential oils actually good for your skin? I’ve heard conflicting advice.

ANSWER: So many of my patients swear by their essential oils. They can be energizing, relaxing, and everything in between. Diffusing them can be helpful in terms of mindfulness and anxiety reduction, which is very beneficial to the skin. In addition, some people like to use essential oils topically –whether diluted with a carrier oil or already incorporated into skincare products. Importantly, some essential oils are photosensitizing, meaning, you should not put them on your skin if you are going to be out in the sun. Some examples are: bergamot, bitter orange, grapefruit, lemon, lime, verbena, and several others. Be sure to check the information which accompanies your essential oils, as many are labeled photosensitizing! Also, certain essential oils can cause significant irritation when applied to the skin, especially if applied without diluting them first in a carrier oil. In fact, I always recommend diluting them in carrier oils before using them topically on the skin. I think a determination as to skin benefits would really need to be made on a product by product basis because essential oils are used at very different levels and for different reasons in particular products. For example, some companies use very minimal amounts of essential oils for fragrance purposes only whereas some products boast higher concentrations. I always recommend that my patients try a “patch test” if they are trying a new product, meaning that you would want to try the product on a small space on the inside of your arm to determine whether you have a reaction/experience irritation. Due diligence in this area is very important – research your oils before applying topically.

Dr. Whitney

 

Retinol seems to be on everyone’s mind lately! I am getting so many questions about retinol in my office, from the press, and on social media so I wanted to share a quick Q & A in case these questions were also on your mind.

Q: What is Retinol?

Dr. Bowe: Retinol is a Vitamin A derivative which is often added to topical skincare products to promote skin renewal, brighten skin tone, reduce acne, and boost your skin’s collagen production. It also functions like an antioxidant to help address free radical damage which leads to visible signs of aging. Retinol is over the counter, so we are talking about the products you can buy in stores – this does not require a prescription.

Q: I’ve heard that retinol is going to make my skin inflamed and red and then peel. Is this true?

Dr. Bowe: I often recommend introducing retinol slowly into your skincare regimen (not every single night) and starting off with a low percentage (0.025%). Retinol can be very irritating if used too frequently or if the formulation is too strong for your skin. Overuse of retinol can cause flaking, redness, and burning, not to mention retinoid dermatitis, which means red scaly patches which sting and burn. There is some peeling associated with retinol use. I recently demonstrated the way I suggest that my patients apply retinol on Good Morning America to reduce inflammation and irritation.

Q: How should I prep my skin prior to makeup application when it’s peeling from retinol?

Dr. Bowe: I recommend gently exfoliating with a scrub or mask made for the face. Using one with sugar or salt is way too harsh for delicate facial skin. My Exfoliating Honey-Avocado-Yogurt Mask from The Beauty of Dirty Skin is a great one to try (p. 174):

Yogurt contains lactic acid which is a natural exfoliant. It also has soothing properties, which are so important when your skin is healing.  To make: mash together half a peeled and pitted avocado and 2 teaspoons of honey until the mixture is a paste. Add one small container of plain Greek yogurt and mix well. Apply to your face and leave on for up to 20 minutes. Rinse off with warm water and pat dry.

Then, apply a moisturizer and let it absorb. I would avoid toners, and don’t give into the urge to scrub with a harsh scrub, or peel at the skin!  Less is more during this fragile time. Probiotic products are especially helpful at promoting healing. I share links to a number of brands I like here.

When you apply makeup, you want to avoid anything with alcohols, and I’m a huge fan of mineral makeups for peeling skin.

Q: How long does it take a retinol to work?

Dr. Bowe: If you are using retinol to address wrinkles and signs of aging, studies show that you will start to see noticeable results in about six months. These results only continue to improve and are even more noticeable at approximately one year after use. Stay consistent with it and you will see results! Be patient!

Q: Can you make some specific product recommendations?

Dr. Bowe: dermalogica’s overnight retinol repair has been one of my favorites for a while. I included it on my Dr. Whitney’s Picks page because it’s so non-irritating and good for people with sensitive skin who are just starting to use a retinol. You can read more about it here.  If you are a seasoned retinol veteran, one of the new products on the market you might consider is Sunday Riley’s A+ High Dose Retinol Serum.

Dr. Whitney

@DrWhitneyBowe

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